Medicare Resource Center

Coverage Available for Uninsured with Pre-existing Conditions

If you have been without health insurance for at least 6 months due to a pre-existing condition, you may be eligible for health insurance under the new health care law. An important provision in the new law provides $5 billion in funding to offer temporary health insurance to many who cannot get health insurance through other means.

The program began accepting applications July 1.

This federal high-risk pool, officially known as the Pre-existing Condition Insurance Plan (PCIP), is a first step to help people with pre-existing conditions get the insurance coverage they need. This temporary program will operate until Jan. 1, 2014, when individuals will be able to buy health insurance through state-based exchanges.

Wyoming opted to have the federal government run its high-risk pool.

To be eligible for the federal Pre-existing Condition Insurance Plan, you must have been uninsured for 6 months, have a pre-existing condition, and be a United States citizen or national, or be lawfully present in the United States. Individuals will be accepted on a first-come, first-served basis.

The federal Pre-existing Condition Insurance Plan covers a range of benefits, including primary and specialty care, hospital care and prescription drugs. All of these health plans are required to cover pre-existing medical conditions.

Premiums are determined by a number of factors, such as your age and state where you live. Yearly out-of-pocket costs will be limited to $5,950 for individuals, not including the premiums you pay.

The federal Pre-existing Condition Insurance Plan began accepting applications July 1. The high-risk pool coverage will stop on Jan. 1, 2014 when individuals will be able to buy insurance through state-based exchanges.

You can find more information on the federal Pre-existing Condition Insurance Plan and get an application for this temporary insurance coverage at www.healthcare.gov.